[The role of echography in the management of fetal macrosomia].

Macrosomia remains an important cause of perinatal morbidity and mortality and maternal morbidity, which arise mainly from birth injury and asphyxia and increased rate or cesarean section respectively. In spite of many attempts to identify the patients at risk for fetal macrosomia, the perfect prediction has not yet emerged. In the last years, many papers have reported methods for ultrasonographic determination of fetal weight. It should be emphasized that most of these reports have cautioned that sonographic predictive accuracy declines as fetal weight increases toward 4000 g. In our study, sonographic prediction of diagnosis of macrosomia was performed in 73% of cases. In addiction, in case with a correct sonographic diagnosis of macrosomia, a higher incidence of primary operative delivery was reported, and when operative delivery for failure to progress was performed, the time of labor was shorter in patients with ultrasound diagnosis of macrosomia. The proportion of babies with apgar score greater than 7 at 1 minute, the incidence of shoulder dystocia and birth trauma was similar in the patients with and without prenatal ultrasound diagnosis of macrosomia. This study does not justify the use of elective cesarean section as a method of preventing persistent infant morbidity. An accurate antenatal diagnosis of macrosomia with ultrasound has been shown to offer an important usefull in the clinical management of labor and delivery.